Episode 253: The International Risks Associated with Oncology and Global Health Equity with Dr. Joachim Schüz
This week on The International Risk Podcast, we’re joined by Dr. Joachim Schüz for a critical conversation on why cancer prevention must be treated as a global systems risk, not simply a medical challenge. Dominic and Dr. Joachim Schüz explore how exposure to toxins, industrial expansion, regulatory failure, and political inertia are reshaping the global cancer burden, particularly in low- and middle-income countries.
They unpack the paradox: over 40 percent of cancers are preventable, yet only 5 percent of global cancer funding goes to prevention. From air pollution and pesticides to trade deals and workplace standards, they examine how commercial incentives and political short-termism continue to undercut basic prevention measures, and how these choices quietly externalise cancer risks across borders.
As cancer risk increasingly mirrors patterns of inequality, Dr. Schüz reflects on the intersecting roles of governments, multinationals, and international institutions in addressing the social, occupational, and environmental conditions that shape who gets sick, who gets treatment, and who is left behind.
Dr. Schüz is the Head of the Environment and Lifestyle Epidemiology Branch at the International Agency for Research on Cancer, the World Health Organization’s leading cancer research body. With over three decades of experience, he has played a central role in mapping the links between environmental exposures, structural injustice, and cancer incidence. His work challenges us to rethink cancer prevention not only as a public good, but as a question of long-term strategy, international responsibility, and ethical governance.
The International Risk Podcast is a weekly podcast for senior executives, board members, and risk advisors. In these podcasts, we speak with experts in a variety of fields to explore international relations. Our host is Dominic Bowen, Head of Strategic Advisory at one of Europe’s leading risk consulting firms. Dominic is a regular public and corporate event speaker, and visiting lecturer at several universities. Having spent the last 20 years successfully establishing large and complex operations in the world’s highest-risk areas and conflict zones, Dominic now joins you to speak with exciting guests around the world to discuss international risk.
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Transcript:
[00:00:00] Joachim: “Cancers is a kind of a general task for all countries, and international collaboration is very important. And then we also have to make sure that we are not with our ignorance, even having a more extreme cancer situation in these countries that are troubled in a more general sense.”
[00:00:27] Dominic: Welcome back to the International Risk Podcast. Today we’re exploring why cancer prevention is not just a public health issue, but an international risk and a global risk management. Failure from tobacco and toxins to vaccines and infrastructure who gets protected and who doesn’t get protected tells us everything about the architecture of global health equity.
While innovation in oncology captures headlines from cutting edge immunotherapies to artificial intelligence diagnostics, we need to remember that 40% of cancers are still preventable, but prevention rarely captures political will. Funding – now, that’s not a medical failure. It’s a systems failure. It’s a significant risk, and the consequences are global.
Our guest today is Dr. Joachim Schüz. He’s the head of the Environment and Lifestyle epidemiology branch at the International Agency for Research on Cancer. They’re the WHOs leading cancer research body, and he spent over three decades leading global investigations into how the environments we live in, the jobs we perform, the air we breathe all determine our cancer risk. His work on childhood cancer, on occupational exposures and prevention policy is reshaping how we understand health equity, not as a charity, but as a function of strategy, of regulation and of risk management. Dr. Joachim Schüz, welcome to the International Risk Podcast.
[00:01:48] Joachim: Thank you so much, Dominic, and for the introduction.
[00:01:51] Dominic: Dr. Joachim Schüz, over 40% of cancers are preventable, yet only 5% of global cancer spending goes to prevention. In risk management terms, this would be seen as well maybe negligence. What are the political or even commercial forces that are disincentivizing prevention and who benefits from that inertia?
[00:02:09] Joachim: That’s a really good question, and of course we are wondering ourselves why. Cancer prevention is so underfunded because we think we can be pretty clear about all the advantages of early prevention, and here we talk about primary prevention, so that’s even before people develop cancer, which I think given the suffering that comes with a cancer disease, I mean it’s not only dying of cancer, we shouldn’t forget that cancer really comes with a lot of side effects during the treatment, and the whole family is affected.
So I don’t think anyone wants to have cancer. So if you look at the facts, I mean, we always think that people should cheer when we tell them about cancer prevention. It’s 20 million new cancer cases every year, patients every year worldwide. So that means a hundred million in five years. 10 million people are dying of cancer every year.
That’s fact number one. We also noted cancers on the rise, and this is actually the reason is demographic development. There’s more people, people are getting older and the older you get the more possibilities of developing cancer. So this kind of good news of increasing life expectancy comes automatically with a larger number of cancer cases.
And, the third one is what you mentioned, that in theory we know how to prevent well up to 40% of cancer, even if you stay a little bit more realistic, probably 25, 1 third of all cancers can be prevented with more rigorous efforts. We wonder why it is not cancer prevention more funded, has more visibility in the political agenda.
I think one of the reasons is this delay between the investment and actually the good outcome, because cancer is a disease that develops very slowly. Sometimes the first initiating damage is already done at teenage age. So take for instance, one of the most aggressive forms of skin cancer. We know that sunburns and sun exposure during teenage years is a high risk factor for this cancer.
But still, you develop the cancer only at the age of 60, 65 or 70, so that’s 50 years to go. That means for the health decision makers, they have to make an investment that is costly, that is investing money for something that pays out so much later. But also for the individuals, it’s of course a little bit of barrier because when you’re 15, when you’re 20, you’re feeling invincible.
So why care about the disease that you’re getting 56 year later? You always think probably, oh, I can deal with it at a later stage. Why should I stay out of the sun? Oh. It’s nice sun sitting at the beach with a little drink, which by the way is also carcinogenic. So that’s a difficult combination. We really have to win over people to understand that the investment has to be today, because otherwise we are getting an even worse cancer epidemic because it’s not only the costs for the treatment in the long run.
It’s also where should all these oncologists come from? Where should all the nurses come from? Who’s caring about the rehabilitation? Where should this massive workforce just dealing with cancer patients come from? That’s the questions that we are having today, and I think the only answer to this is cancer prevention.
[00:05:09] Dominic: And low and middle income countries now account for about 70% of global cancer deaths and many face rising exposure due to carcinogen because of industrial expansion. Weak regulation in many developing countries, climate vulnerability in many low and middle income countries. So from a global risk governance perspective, where is the accountability when high income countries are externalizing cancer risks through trade pollution or even pharmaceutical inequalities?
[00:05:38] Joachim: One should not get the impression that cancer is a disease of low middle income countries, so it’s the disease of the socially disadvantaged in high income populations. Unfortunately, cancer’s a problem of everyone, but it’s worse in low middle income countries, and it’s worse than the socially disadvantaged population cancer, and very common in high income countries, but as you say, the mortality treatment and survival is better in these countries. So this is why the mortality burden is especially high in the low income countries. That’s a little bit the result at all stages. There’s of course, the different exposure situations, so the likelihood of getting cancer, which differs by country, which differs by population.
That’s the question of the early detection, because the earlier cancers detected, the better the treatment possibilities. And then of course, it’s the accessibility to treatment and of course the affordability of treatment. And here it’s especially the last part that makes cancer such a deadly disease in low middle income countries.
Sometimes it’s the health systems or infrastructure is sometimes it’s such terrible state that you know, you don’t have any fast solutions. I mean, also then talking about the early detection, early detection and screening only makes actually sense if you then have the treatment. To treat these early detected cancers, so you also have to implement these things in an order that it makes sense.
Cancers is a kind of a general task for all countries, and international collaboration is very important. And then we also have to make sure that we are not with our ignorance, even having a more extreme cancer situation in these countries that are troubled in a more general sense.
[00:07:20] Dominic: You mentioned earlier that cancer is rising.
We’ve got more people and more people living longer. But I wonder if there is a surge in environmental and occupational cancer risks? We know in many developing and low and middle income countries, pesticides, asbestos, air pollution, are big problems, especially in the global south. So given your research and what you and your colleagues are working on, what are some of the early warning signs that we might be missing?
We could be doing better to get ahead of tomorrow’s cancer risks, what should global institutions be doing to preempt them? And what are the trends we’re seeing when it comes to the global south and global North?
[00:07:54] Joachim: The occupational related cancers is a relatively well researched field, but interestingly, 90% of all the studies come from Western Europe and North America.
We sometimes don’t know whether we really can move. Take the situation and say, oh, it’ll be the same in the rest of the world. And actually, the more we do research in the rest of the world, we see it’s not the case. I mean, the exposure circumstances are different. The workers’ protection possibilities are different.
I mean, in many countries, children already start working or people start working at a much earlier age. I think lifelong longer. Exposures and also the baseline risk of cancer is different. So the different co-exposures that you’re having is also a different situation and sometimes its synergies with the different carcinogens that actually make it worse.
We know almost a hundred chemicals that are established human carcinogens that we have identified through these studies at people’s workplaces. But the tricky question is we have for many of these chemicals, not really understood at what levels and what especially. Cumulative levels over your lifetime, they can really substantially increase the cancer risk for many of these chemicals.
We know that at the workplace where you usually have a high exposure, this is related to an increased cancer risk, but even for the same chemical when it occurs at environmental levels, we have not really understood how big the cancer risk. This is, for instance, one of the questions because as we both said, already 40% of cancers can be prevented.
That means for more than half of the cancers, we don’t know where they come from. So actually environmental levels of the same chemicals that we perhaps know from the occupational setting could cause a much higher cancer burden based on our lack of understanding. What really happens at low levels is the threshold for certain chemicals.
The risks are so small that it’s not really detectable. These are all questions that we need to address. And, with new methods like biomarker measurements, we start to call it the ‘exposome’ when we actually want to reconstruct the person’s life based on a combination of what we find in the person’s body, in blood, in other tissue.
At the same time, try to model what people did in their life. This X person gives us hopefully a better understanding of how this all comes together. I can give you one example because you mentioned the pesticides. Europe, North America, we usually assume that having a job as a pesticide applicator is one of the ones with the highest exposures because you know, you’re dealing with the pesticides all the time.
And this also is what you find when you measure pesticide residuals in those person’s urine. For example, now in Africa, we have new findings. So that showed that actually the pesticide applicators have among the lowest levels because they are the only ones that are having protection equipment with them when they’re spraying.
But the farms are so small in scale that usually the whole family and all the field workers are around when the pesticides are being sprayed on territory that is hardly bigger than the auditorium here, the agency, it’s relatively small, so meaning that all these peoples are exposed to the same pesticides, but not having any equipment to protect themselves, and you even have to laying next to the field and being exposed as well, putting soil in their mouth, et cetera, et cetera.
And these are all exposures that we need to understand better if we really want to quantify the en environmental related cancer risk is. Especially in these socially disa disadvantaged populations,
[00:11:26] Dominic: We know that there are over a hundred known human carcinogens, but we don’t necessarily know at what level.
And, it draws me back to a service for the Australian governments. And I know certain government agencies, including the Australian Defense Force, actually covers cancer for veterans. If you get cancer and you’re a veteran of the Australian Defense Force, because they know that aircrew we work in the Air Force, have a 75% high rate of melanoma, 31% high rates of thyroid cancer, 20% higher rates of prostate cancer. And the same for infantry and special operations forces have much higher rates of melanoma, different bone cancers, which is quite interesting.
So the Department of Defense hasn’t admitted or hasn’t acknowledged their role in the higher rates, but they’ve certainly said if anyone gets cancer after being a veteran within the Australian Defense Force, we will cover your cancer treatments, which is quite interesting.
It’s quite sad they don’t tell veterans this. You’ve gotta work very hard to actually find that out. But certainly this is something that at least at some government agencies, have. Is there studies going on to help understand, because we often hear about safe levels of drinking water and certain chemicals in foods and plastics in our toothpastes.
How close are we to actually understanding, at what point do these toxins become toxic?
[00:12:34] Joachim: This safe level is, difficult concept because at one stage the risk is probably becoming so small that it’s not measurable anymore, but it would still not rule out individual cancer cases under. Special circumstances, so usually we define a safe level as something that accepts still some kind of residual risk in people.
If the risk is becoming smaller than one in something, depending on the chemical, then we define this usually as a safe level, but it doesn’t mean it’s totally safe and no effect is anyway, practically impossible to prove from a scientific point of view, the difficult question, when do we start? When do we stop studying a chemical? How many studies do you need to really conclude? Oh, well, this is at least reasonably safe. The early studies that we do, usually we have to understand the exposure. Then sometimes we see when we do the studies and we make validation studies of the exposure measurements, we see, oh, a lot of our assumptions were actually wrong.
And it turns suddenly out that those that we thought were the most exposed actually aren’t, and it’s the other way around. So every study builds on another, but at what stage do we say, okay, now we know enough for actually concluding on this? There’s many examples. Then when you see the effect relatively late, when you see it as a cancer burden, then obviously it was too late.
And then you probably have to take action as quickly as possible to make sure that you have the special protection measures in place. And construction workers, for instance, are at higher risk of also getting cancer. It is known for a long time. It’s the inhalation of the different types of dust in the air.
In the worst case, they inhale asbestos from the buildings that were built at a certain time, and asbestos was very common. It’s really a bad combination and countries do have compensation schemes as well, but they also differ quite significantly from country to country of what you get out for it relatively early.
It was suggested that provision of masks by employers would help a lot, especially for the inhalation. And we have been told for many years that where should all these masks come from? Then suddenly we all remember there was an event not too many years ago where there was suddenly no shortage of masks.
There were millions more people wearing masks than the construction workers. We always have to challenge when you hear something is not possible or something is not doable, or something is not affordable – you just can’t give up. You always have to remind, no, we need this prevention. It’s an investment for the future.
It’s more expensive for everyone. It’s more expensive for the health system to treat all the cancer cases. It’s also a loss for the employer, an employee who’s sick. And especially long-term sick is also expensive and truly more expensive than the provision of some masks.
[00:15:28] Dominic: And you, I know you’ve done a lot of research on this Joachim, and you’ve considered by many an expert in this – can you tell us about the ways in which cancer prevention intersects with environmental regulation, with urban planning, with commercial influence? How do these sectors come together to lead to cancer prevention?
[00:15:47] Joachim: That’s actually a good question because at the moment we are discussing this a lot, and especially in the context, do we find synergies between cancer prevention and climate change mitigation because that probably would convince even more people to say, okay, we have to invest because it is two terrible things that we don’t want to have in the future. And there are actually a lot of synergies as we can see, and it’s the food production that is one very obvious one. And we see that reducing the meat production would be very good for the green gas emissions.
But at the same time, we know that too much meat is also causing different types of cancer. So that would be a win-win situation. We see the same synergies actually by looking at reducing air pollution with more parks, trees, green spaces, and cities. And also encouraging people for more physical
Cycling to work, using public transportation, which usually also involves a little bit of walking and running after the bus or the drum to catch it. And instead of just sitting in the SUV and driving to work, that would all be things that would help in cancer prevention, help reduce the cancer burden at the same time, of course, mitigate the climate change.
And that’s certainly a new era in the environment field. And we hope that gets even more stakeholders on board helping to implementing all these measures
[00:17:13] Dominic: Prevention programs typically yield results over the long term. And you talked about this Joachim, whereas treatment and research investments produce more immediate visible results and.
Politicians and policy makers usually favor initiatives with quick tangible outcomes that can be showcased within their election cycles, within their annual report. And of course, this makes prevention much less attractive as a funding priority. I suspect this is not the entire story. So why is cancer prevention, despite its proven effectness, so often underfunded or politically deprioritized in national health agendas?
[00:17:49] Joachim: There’s many additional reasons, even if it doesn’t probably sound like this. Cancer prevention is a relatively new field. If you look at how slow cancer develops, especially, I mean, it more or less started with the identification of the causes of cancer that there’s some total example or some great examples that the cancer that was detected in the chimney sweepers, that’s a finding that is actually this year, I think getting 250 years old, but the really systematic studying of courses of cancer, that discipline is not even a hundred years old.
And I think people were thinking when they became enthusiastic and did all this research that everybody would just jump on the results and you would have difficulty stopping people for putting this all in practice to to prevent cancer. But then we realized that there’s more needed. And even if you know the cause of cancer, you need to know the interventions that you have to do that are effective to make the prevention.
And that created this whole field of intervention studies. And now we are seeing that even, it doesn’t stop at the level of intervention, but in the interventions. One size doesn’t fit all. And you practically, when you roll out your campaigns in the population, when you try to implement all this cancer prevention, you need implementation research to find the optimal way for your target population that can be even different within a country that probably it has to be age specific. You have to take even the cultural context within a country into account. So the implementation research is a very new discipline, and the more insight we get from here, the better advice we can also give for the policy makers.
Another barrier is what we, in a fancy way, try to call the commercial determinants. Health, and this is that unfortunately, many of our unhealthy lifestyles create a lot of profit for different industries. And I mean how successful the marketing of tobacco products has been. We could fill a whole podcast probably on this one, but I remember when I was young, the people were coming to the pub and giving you free cigarettes and your coworker in your office was still allowed to smoke.
It’s a long way from them, but these marketing people, they’re not paid for nothing. They’re developing always new ideas. If you look at the major single cause of cancer, which is really the smoking in Europe, it’s responsible for 20% of all cancers. That’s practically half of all preventable cancers.
Even with all the successes – in tobacco prevention today, we have the highest number of smoking related cancers in Europe. Of these demographic changes, yes, the risk is going down, especially in the men. Unfortunately, not so much in women, but since the at risk population is increasing, the numbers of smoking related cancers is still going up.
And now when we see the vaping products and we see the first, you know, evidence that shows that people who start with vape are more likely to become conventional smokers later on, it shows that even for this, you know, very obvious factors that we are still behind. This is of course we have to overcome here, very strong vested interest, and that applies not only to the tobacco industry.
This applies as well to the alcohol industry. This applies to the food industry. This applies to the sunbeds, and unfortunately also to many that cause these emissions that we find in the environment.
[00:21:11] Dominic: And I’ll just take the opportunity Joachim to remind our listeners to go to the International Risk Podcast website and subscribe to our newsletter to get the latest news information and of course, podcasts in your inbox every second week, so go to the International Risk Podcast website and have a look.
But Joachim, cancer risk and outcomes. They’re not just a matter of individual behavioral or biology, but as you’ve talked about and as you’ve got very close to talking about, they’re deeply shaped by these social, economic, and even political structures, where people live, where they work, what protections that you talk about, what resources have access to a fundamental determinants of cancer risk, and of course, survival.
What does the global distribution of known cancer risk factors, such as tobacco use, air pollution, occupational exposure, infections, reveal about the broader patterns of structural health inequality?
[00:22:03] Joachim: We are raising two very important points here. One is the global distribution where we do see a lot of similarities even, but also some very specific differences.
Sometimes we can even identify cancer risks that are in a very kind of localized area, but something like tobacco is of course a more or less global problem. So even in countries where you think that it’s secrets would be almost unaffordable. It’s still interesting to see that somehow people manage to become smokers, even when not so heavily like in other countries, but that’s clearly a global fight.
Infections, of course, is one where you really have very strong geographical patterns because that’s of course, where the underlying infections are occurring. But there’s also one that is really global challenge, which is the humor papilloma virus for the cervical cancer, which is also, unfortunately really a more common deadly cancer in low income countries.
But it’s also a major problem in all high income countries. But what you also raised in your question is the more important point, but you cannot give the responsibility just to the individual. It’s important that the individual knows. And this is not only for your own behavior in everyday life.
Yes, of course it will be great if you can adjust your behavior a little bit, but also if there’s a kind of critical mass of people understanding what needs to be done, then also these individuals can come together and put the political pressure together that actually needs to consequences more on a society level.
And that is done by the governments because that’s really important. Can give the European code against cancer as an example, that exists for almost 40 years. And we are at the moment working on the fifth version and the fifth version will for the first time combine these individual behavior recommendations together with policy recommendations that all countries see in Europe can see what is already possible by taking the good examples from countries that have implemented something.
But we know that a lot of these individual behavior changes. Don’t work without support from the governments. Take the UV, the sun exposure. You can tell people stay in the shade, but if, for instance, kindergarten schools. Not having any places where you find these shade, then it’s a useless recommendation.
We mentioned already to tobacco for the individual, it’s extremely difficult to stop, and that’s of course because of the addiction to the nicotine, and I know the optimization of the chemical cocktail of a cigarette, that makes it very difficult for people to stop. We even have smokers who say, I mean, yes, you’re making the secrets more expensive and it’s painful, but we understand that this is probably the only way forward of really reducing rates and smokers, and it’s a continuous process. It doesn’t work overnight and a lot of countries actually have now seen, one really has to start much earlier, and this is prevent people from ever becoming a smoker because you don’t miss anything. If you’re never smoke in your life, there’s nothing. You just think you miss something once you are a smoker and you have to stop. These generation changes. This is something that is also relatively new research field, but that sounds very promising. Get people used to a healthy diet from a very early age on so that it’s not felt like, oh, if I have to stop eating sausages, and I’m saying this here as a German, if I have to stop eating sausages, my life will just become terrible, you know?
But if young generations growing up with seeing that, a healthy diet can be a tasty diet and can be an interesting diet, then it’s much easier to keep a healthy diet throughout your life. So smoking, alcohol and nutrition are really three areas of this, and I think, yeah, the help from governments is needed, and I mean in sectors like occupational cancer, environmental cancer, here we are even talking about. Here you have to define protection limits. Here you have to direct legal action because the exposures at your workplace. This is beyond people’s own control. Here, you have to rely on that. That really what is somebody cares about you.
[00:26:16] Dominic: Thanks very much for explaining that Joachim,, except for the bit about sausages, I don’t want anyone to think that the International Risk Podcast is against meat products. That would be a step too far. But Joachim, I’d love to ask you two questions. One is about the state’s responsibility and also the responsibility that multinational firms have, and tariffs and trade deals are really on the lips of all politicians or CEOs right now.
We know that trade deals routinely override or ignore local health regulations, whether it’s around pesticide standards, tobacco marketing. So I wonder if cancer prevention has been sufficiently considered in trade negotiations, and I wonder a multinational firms exploiting these gaps to shift cancer risks on to poorer countries.
But similarly, we know that many countries are relaxing their environmental standards. They’re relaxing their workplace regulations in order to attract. Foreign investment, especially in industries like mining, agricultural textiles, manufacturing, and the outcomes often means increased exposure to cancer risks.
So in your view, how can governments and multinationals strike a balance between economic development at the same time as protecting populations from long-term health consequences?
[00:27:30] Joachim: The very short answer to your question, are these prevention measures regarded in trade agreements, et cetera, would be no – but they should be, and you are totally right. And we can only emphasize that disease is also an economic cost. So I guess with making health economics the more routine part also of our predictions on cancer burden, et cetera, et cetera. Will deliver this message much more clearly. And then it’s really the question whether maybe a relatively limited short-term profit really worth, I mean treatment costs that can be manyfold higher in the future.
So that’s clearly, that’s clearly one point. And the other thing is, I guess what maybe some are also not so aware about is that, even casino chains occurring in one part of the world are a global problem because they don’t stay there. They’re just consumer chains that don’t need a visa. I mean they just go where they want or they stay where they want. And here the radiation is a good example. You find radio NU lights, from nuclear testing or from use of nuclear weapons, you find them everywhere because the wind carries them everywhere. Of course, not to the same extent that the place where the testing took place, but you know, there’s no borders that keep them out.
And the same is true of course, for the infections. That’s the same, but also for other chemicals make their way back to us, even when we probably export them from the high income countries to the low income countries, the pesticides, then they’re used over there, but then they’re coming back with the foods because they were applied, of course, on the vegetables, on fruit or other products.
I mean, we had an interesting finding when, here in France, we actually made dust measurements in people’s home. We were actually looking for more pesticides presently in use. But then we found actually a substantial number of homes where we found traces of long band pesticides like DDT.
And this is a reminder, even when you spell out a ban on a certain chemical, I mean, this chemical is not saying, oh, there’s a ban I have to leave. No, this chemical is staying where it is. So you also need the remediation and the consequences. This has to be factored in. So the more we pollute the entire globe, we should not just say, oh, we are safe because the pollution happened somewhere else.
Sooner or later, all these substances come back from where we sent them in the first place.
[00:29:47] Dominic: And in a protracted crisis, if we think about Syria, if we think about Sudan, if we think about Gaza, there’s collapsed health systems, failing early detection systems, insufficient health screening, inadequate environmental monitoring.
This is all well understood. But cancer doesn’t pause for war, obviously. What does your research suggest about how conflict zones compound long-term cancer risks? What obligations do international electors have to prevent the invisible fallout from their support to conflict zones where health systems are failing?
[00:30:20] Joachim: That’s a very good point. And it’s probably a rather neglected field as well, and by rebuilding infrastructure after war, again, you don’t find cans on top of the list, but of course it’s, it’s an opportunity because if you rebuild from scratch. And some of the countries have to do that. That would be also a good place for having these long-term investments in place because you have to invest anyway, so spend some thoughts already.
The things that will probably pay out in the future, because yes, there’s some immediate need that have to be fulfilled. But I mean the cancer will be there even 50 years after the conflict and maybe in the rebuilding you can take care of a lot of things that you can implement in a way to have benefits really for the future. But it’s totally true. I mean it all, the exposure patterns of people, it’s certainly diet. It’s the environment that, I mean, usually early detection of cancer totally collapsing. We saw it in many countries also during the pandemic. Didn’t even have to be a war. And of course, usually treatment facilities are destroyed and you cannot use the optimal treatment for cancer cases.
On the other hand, what we also see, I mean, humans are also more resilient than we sometimes think. And, even when cancer affects really a massive number of cases, we should also always be aware that, you know, our body’s very strong. So with adequately supporting it. We also have a good chance to become very old.
[00:31:52] Dominic: And we’ve spoken a lot about cancer risks and trade deals and conflicts and different exposure levels in low and middle income countries.
When you look around the world Joachim, what are the international risks that concern you the most?
[00:32:04] Joachim: There’s rather a lot of homework to do. I think really the first priority should be the implementing of what we know. It’s a massive number of cancers that we could prevent today if we would implement everything that we’ve understood.
Sometimes I also don’t like it when people always come and say, oh, we need novel ideas. We need novel ideas. What can we do? What can we do? Maybe sometimes, you know, the implementation of old ideas is great. Yes, we have evidence now that lung cancer screening and high risk populations is beneficial and people get very excited about it, but at the same time, I hardly know any country where the screening for colorectal cancer, for breast cancer is implemented in a way that, that it really has the benefit that it could have because the uptake in the population still low and one should not forget the investment into things that we know for a long time just because of getting excited by something new and there’s a tendency for it.
And I think especially some of the exposures that have been around for a long time probably need some radical changes and the time may be ripe for really, uh, I mean, addressing the tobacco epidemic in a very different way. Make sure that really future generations do not run into this trap of starting to smoke because we’ve understood how difficult it is to stop smoking again, and we can de-normalize the alcohol consumption.
In many countries, we can see there’s populations who also look quite happy who are not drinking alcohol, so it seems to be possible. And also the healthy diet is really something that is very high on the list. And if these three big ones would be implemented, then we can, you know, work further and see, can we do something for very specific populations, et cetera, et cetera, to protect further.
But let’s do the homework first. That has been on the list for a long time. And that will be a massive game changer for the cancer burden in the world.
[00:34:08] Dominic: Oh, thanks very much for that insight. I really appreciate that Joachim, and thank you very much for coming on the International Risk Podcast.
[00:34:13] Joachim: Thank you very much for the invitation. It was a very delightful conversation.